Clinical profile and factors associated with microalbuminuria in type 1 diabetes mellitus in children and adolescents
Keywords:Microalbuminuria, Cholesterol, Diabetes mellitus
Background: The aim of this study was to determine the pattern of clinical presentation and factor associated with microalbuminuria.
Methods: Urinary albumin excretion of children and adolescents diagnosed with type 1 diabetes mellitus attending diabetic clinic of Katihar medical college hospital over a period of one year. Collected blood and urine samples were analysed for glycated haemoglobin, cholesterol, triglycerides, and for 12 hour urinary albumin concentration. Blood pressures were recorded and clinical data collected.
Results: During the study period 215 patients were diagnosed with type1 DM. Out of 215, fourty-three patients (20%) had persistent microalbuminuria. Factor associated with microalbuminuria in diabetic patients include duration of diabetes mellitus, higher blood pressure, higher cholesterol and triglyceride levels.
Conclusion: Type 1 DM is treatable and testing is acceptable and accessible to the patients. As microalbuminuria is an early microvascular complications, it is highly recommended to screen all diabetic patients for the incidence of microalbuminuria and modifiable risk factors like dyslipidemia at the onset and then yearly assessment. Efforts need to be intensified in education of health workers and population at large for quick presentation and prompt diagnosis in order to predict overt diabetic nephropathy and also to prevent its progression.
Brijan Roshan, Robart C. Stanton. A story of microalbuminuria and diabetic nephropathy. J Nephropathol. 2013 Oct;2(4):234-40.
Patterson CC, Gyurus E, Rosenbauer J, Cinek O, Neu A, Schober E, et al. Trends in childhood type 1 diabetes incidence in Europe during 1989-2008: evidence of nonuniformity over time in rates of increase. Diabetologia. 2012;55:2142-7.
WHO. Diabetes, 2014. Available at: www.who.int/medicenter/factsheets/fs312/en. Accessed 13 December 2014.
Parita Patel, Allison Macerollo. Diabetes mellitus: diagnosis and screening. Am Fam Physician. 2010 Apr;81(7):863-70.
Poovazhagi V, Prabha Senguttvan, Padmaraj R. Prevalence of microalbuminuria in children with type 1 diabetes mellitus. Pediatric Oncall J. 2012 July;9(7):43.
Defronzo RA. Diabetic nephropathy. In: Porte D, Sherwin R, eds. Ellenberg and Rifklin Diabetes Mellitus. 6th ed. New York: McGraw-Hill Companies; 2004: 723-740.
Francis J, Rose SJ, Raafat F, Milford DV. Early onset of diabetic nephropathy. Arch Dis Child. 1997;77:524-5.
P. Raghuramulu, Uma, Kavita, Laxmi Rajyam, Srinivas, P. Sandeep Raman. Prevalence of gestational diabetes in rural Andhra Pradesh. J Clin Sci Res. 2013 April-Jun;2(Suppl 1):S5.
Ibekwe MU, Ibekwe RC. Pattern of type 1 diabetes mellitus in Abakaliki, South-Eastern, Nigeria. Pediatric Oncall. 2011 Jul;8(7):99.
Omoshalewa Ugege, Paul Kehinde Ibitoye, Nma Mohammed Jiya. Childhood diabetes mellitus in Sokoto, north-western Nigeria: a ten year review. Sahel Med J. 2013;16(3):97-101.
Chaturvedi N, Bandinelli S, Mangili R, Penno G, Rottiers RE, Fuller JH. Microalbuminuria in type 1 diabetes: rates, risk factors and glycemic threshold. Kidney Int. 2001 Jul;60(1):219-27.
Gallego PH, Bulsara MK, Frazer F, Lafferty AR, Davis EA, Jones TW. Prevalence and risk factors for microalbuminuria in a population based sample of children and adolescents with Type1diabetes mellitus in western Australia. Pediatr Diabetes. 2006;7:165-72.
Schultz CJ, Dalton RN, Turner C, Neil HA, Dunger DB. Freezing method affects the concentration and variability of urine proteins and the interpretation of data on microalbuminuria: the Oxford regional prospective study group. Diabet Med. 2000 Jan;17(1):7-14.
Moore TH, Sheild JP. Prevalence of abnormal urinary excretion in adolescents and children with insulin dependent diabetes: the MIDAC study. Microalbuminuria in diabetic adolescents and children (MIDAC) research group. Arch Dis Child. 2000;83(3):239-43.
Patel KL, Mhetras SB, Varthakavi PK, Merchant PC, Nihalani KD. Microalbuminuria in insulin dependent diabetes mellitus. J Assoc Physicians Indian. 1999 Jun;47(6):589-95.
Zahara Razavi, Hossein Emad Momtaz, Somayeh Sahari. Frequency of microalbuminuria in type 1 diabetic children. Iran J Pediatr. 2009 Dec;19(4):404-8.
Alleyn CR, Volkening LK, Wolfsan J, Rodriguez-Ventura A, Wood JR, Loffel LM. Occurrence of microalbuminuria in young people with type 1 diabetes: importance of age and diabetes duration. Diabet Med. 2010;27:532-7.
Hyun-Wook Chae, Jae-Ll-Shin, AAh-Reum Kwan, Ho-Seong Kim, Duk-Hee Kim. Spot urine albumin to creatinine ratio and serum cystatin C are effective for detection of diabetic nephropathy in childhood diabetic patients. J Korean Med Sci. 2012 Jul;27(7):784-7.
Basiratnia M, Abadi SF, Amirhakimi GH, Karamizadeh Z, Karamifar H. Ambulatory blood pressure monitoring in children and adolescents withtype-1 diabetes mellitus and its relation to diabetic control and microalbuminuria. Saudi J Kidney Dis Transpl. 2012 Mar;23(2):311-5.
Donaghue KC, Chiarelli F, Trotta D, Allgrove J, Dahl-Jorgensen K. Microvascular and macrovascular complications associated with diabetes in children and adolescents. Pediatr Diabetes. 2009 Sep;10(Suppl 12):195-203.
GrossJL, De-Azevedo MJ, Silveiro SP, Canani LH, Caramori ML, Zelmanovtiz T. Diabetic nephropathy: diagnosis, prevention and treatment. Diabetes Care. 2005 Jan;28(1):164-76.
Holl RW, Grabert M, Thon A, Heinze E. Urinary excretion of albumin in adolescents with type 1 diabetes: persistent versus intermittent microalbuminuria and relationship to duration of diabetes, sex, and metabolic control. Diabetic Care. 1999 Sep;(9)1555-60.
Coonrod BA, Ellis D, Becker DJ, Bunker CH, Kelsey SF, Lloyd CE, et al. Predictors of microalbuminuria in individuals with IDDM. Pittsburgh Epidemiology of Diabetes Complications Study. Diabetes Care.1993 Oct;16(10):1376-83.
Rowe DJF, Hayward M, Bagga H, Betts P. Effect of glycaemic control and duration of disease on overnight albumin excretion in diabetic children.Br Med J (Clin Res Ed). 1984 Oct;289(6450):957-99.
Tuomilehto J, Borch-Johnsen K, Molarius A, Forsen T, Rastenyte D, Sarti C, et al. Incidence of cardiovascular disease in type 1 (insulin-dependent) diabetic subjects with and without diabetic nephropathy in Finland. Diabetologia. 1998 Jul;41:784-90.
Krolewski AS, Warram JTT, Christlieb R. Hypercholesterolemia. A determinant of renal function loss and deaths in IDDM patients with nephropathy. Kidney Int Suppl. 1994 Feb;45:S125-31.
Chatruvedi N, Fuller JH, Taskinen MR. Differing association of lipid and lipoprotein disturbances with the macrovascular and microvascular complications in type 1 diabetes. Diabetes Care. 2001;24:2071-7.
Newman WP III, Freedman DS, Voors AW, Gard PD, Srinivasan SR, Cresanta JL, et al. Relation of serum lipoprotein levels and systolic blood pressure to early atherosclerosis. The Bogalusa Heart Study. New Engl J Med. 1986;314:138-44.
Berenson GS, Srinivasan SR, Bao W, Newman WP 3rd, Tracy RE, Wattigney WA. Association between multiple cardiovascular risk factors and atherosclerosis in children and young adults. The Bogalusa Heart Study. New Engl J Med. 1998;338:1650-6.
Nathan DM, Lachin J, Cleary P, Orchard T, Brillon DJ, Backlund JY, et al. Intensive diabetes therapy and carotid intima-media thickness in type 1 diabetes mellitus. New Engl J Med. 2003;348:2294-303.